Pulmonary arteriovenous malformation: a culprit of middle lobe syndrome?

Middle lobe syndrome [MLS] refers to lobar atelectasis and bronchiectasis and is either obstructive or non-obstructive type. A 63-year-old asthmatic female patient presented with recurrent pneumonia and unrelenting cough which proved to be due to pulmonary arteriovenous malformation that led to obstructive MLS. CT scan showed right middle lobe volume loss, bronchiectasis and dilated pulmonary vessels. The patient was operated for right middle lobectomy. The pathological examination revealed pulmonary arteriovenous malformation with post obstructive changes. Pulmonary arteriovenous malformation should be part of the differential diagnosis of MLS and should prompt early referral for surgery. Middle lobe is anatomically susceptible to obstruction of the bronchus and to atelectasis due to its poor drainage and ventilation. Conservative treatment with antibiotics, bronchodilators, and chest physiotherapy are effective in 33.3 to 66.6% of patients. Lobectomy is required in a third of MLS patients who fail conservative management or have persistent symptoms that last more than 6 months or have malignant obstruction

Right lung middle lobe syndrome as the initial and sole clinical manifestation of Hodgkin's disease

The commonest presentation in Hodgkin's disease is painless cervical lymphadenopathy with or without a mediastinal mass. Uncommon presentations of Hodgkin's disease that has been so far reported include: spinal cord compression, localized poikiloderma vascularis atrophicans, unilateral lower extremity lymphedema, multifocal nodular episcleritis and scleritis, Immune thrombocytopenia and hemolytic anemia, granolomatous keratoconjunctivitis, subdiaphragmatic Hodgkin's disease. In these cases uncommon presentations were extramediastinal. In this case Hodgkin's disease presented with right lung middle lobe syndrome without hillar or mediastinal lymphadenopathy. CT guided needle biopsy of pulmonary lesion revealed Hodgkin's disease and response to chemotherapy was very good. The typical presentation of pulmonary Hodgkin's disease includes multiple, irregularly marginated pulmonary nodules in the hillar or mediastinal areas. Our case had an uncommon presentation of pulmonary Hodgkin's disease. Therefore for early diagnosis and treatment, such presentations of the disease should be taken into consideration

Síndrome do lobo médio: estudo de 10 casos atendidos no Hospital Universitário Lauro Wanderley / Middle lob disease: 10 cases assisted in the University Hospital Lauro Wanderley

Os autores fazem um estudo de 10 casos de síndrome do lobo médio (SLM), atendidos no Hospital Universitário Lauro Wanderley da Universidade Federal da Paraíba (HULW/UFPB), no período de 1986 a 1999. Enfatizam os aspectos clínicos, epidemiológicos e laboratoriais de diagnóstico, inclusive por imagem, comentando cada caso isoladamente. Ressaltam os aspectos radiográficos mais sugestivos dessa enfermidade, visando a instituição de um protocolo terapêutico cirúrgico para posterior seguimento e evolução. Chamam ainda a atenção para a instituição do tratamento tuberculostático precoce, no intuito de evitar seqüelas irreparáqveis no lobo médio, sobretudo sua forma mais temível - a síndrome do lobo médio. Concluem que o tratamento cirúrgico da SLM é considerado imprescindível no sentido não apenas de corrigir as graves deformidades da arquitetura pulmonar do lobo médio, mas também de acelerar a cura.